Provider Demographics
NPI:1457197709
Name:TONNING, JACOB GUNNAR OGLE
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:GUNNAR OGLE
Last Name:TONNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 174TH ST NE APT DD307
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-4872
Mailing Address - Country:US
Mailing Address - Phone:425-736-6666
Mailing Address - Fax:
Practice Address - Street 1:3645 E MCLEOD RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8700
Practice Address - Country:US
Practice Address - Phone:360-676-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health